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Transcranial Magnetic Stimulation for the Treatment of Veterans With Alcohol Use Disorders

Primary Purpose

Alcohol Use Disorder

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Active rTMS
Sham rTMS
Sponsored by
VA Office of Research and Development
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alcohol Use Disorder focused on measuring repetitive transcranial magnetic stimulation, alcohol use disorder, neuroimaging, relapse, Veterans

Eligibility Criteria

21 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • The study will be open to male and females, regardless of race and ethnic origin, who are in active treatment for an alcohol use disorder (AUD).
  • Meet Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria for AUD, and alcohol is self-identified as primary substance of misuse.
  • Actively in treatment at VA Palo Alto HCS Addiction Treatment Service, and able to read, verbalize understanding, and voluntarily sign the Informed Consent Form prior to participation in study procedures.
  • Participants will be accepted if taking medications specifically for the treatment of MDD, cigarette smoking, or for other psychiatric conditions.

    • as long as the medications are not documented to lower seizure threshold
    • must be stable on any psychotropic medication for at least 1 month prior to enrollment
    • it would be clinically contraindicated to require participants to discontinue such medications for research.
  • Participants will be abstinent from alcohol and non-prescribed substances for at least 7 consecutive days prior to active or sham rTMS and no participant demonstrates active acute withdrawal symptoms.

Exclusion Criteria:

Psychiatric:

  • History of Schizophrenia Spectrum Disorders
  • Bipolar Disorders
  • A current substance use disorder that exceeds the severity of the AUD

    • based on DSM-5 diagnostic criteria
  • Current use of an FDA approved medication for treatment of AUD, i.e.:

    • disulfiram
    • acamprosate
    • naltrexone
  • Active current suicidal intent or plan

    • patients with a previous clinical flag for risk for suicide will be required to have an established safety plan involving their primary psychiatrist and the treatment team before entering the clinical trial
  • Any form of previous rTMS or electroconvulsive treatment

Biomedical:

  • Including but not limited to uncontrolled thyroid disease
  • Unstable congestive heart failure
  • Angina
  • Other severe cardiac illness as defined by treatment regimen changes in the prior 3 months
  • Cerebrovascular accident
  • Cancer if < 1 year since end of treatment
  • Unstable diabetes
  • COPD requiring oxygen supplementation
  • Alzheimer's disease
  • Parkinson's disease
  • Any biomedical implants with ferromagnetic content
  • Neurostimulation devices
  • Cardiac pacemakers or any magnetic resonance contraindications
  • Traumatic brain injury with self-reported or observed loss of consciousness > 30 minutes
  • Any primary or traumatically induced seizure disorder

General:

  • Lack of fluency in English
  • Wechsler Adult Reading Test below the 7th percentile, i.e.:

    • moderate or greater impairment in estimated general intelligence
  • Females who are pregnant or actively attempting pregnancy

    • conservative exclusion for magnetic resonance research
  • Current use of any medication or substance that is documented to lower seizure threshold or has been identified as a contraindication for rTMS treatment

Sites / Locations

  • VA Palo Alto Health Care System, Palo Alto, CARecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Sham Comparator

Arm Label

active rTMS

sham rTMS

Arm Description

Active rTMS will receive an intermittent rTMS stimulation protocol.

Sham rTMS will receive all conditions except the actual intermittent theta burst rTMS stimulation.

Outcomes

Primary Outcome Measures

Frequency of abstinence from alcohol and other substances
For the 6 months following completion of active or sham rTMS treatment, participants will be contacted monthly, via telephone or in person, to complete a brief standardized measure of alcohol and substance use, as well as craving, and psychiatric symptoms to assess for changes in these variables over the previous 30 days.

Secondary Outcome Measures

Glutamate concentration in the left dorsolateral prefrontal cortex (as measured with single voxel spectroscopy)
Determine if glutamate level can serve as a biomarker to predict rTMS treatment response in Veterans with AUD.
Volume in anterior frontal cortical regions (as measured with FreeSurfer)
Determine if volume in anterior frontal cortical regions can serve as biomarkers to predict rTMS treatment response in Veterans with AUD.
Functional connectivity (as measured with resting state fMRI)
Determine if functional connectivity can serve as a biomarker to predict rTMS treatment response in Veterans with AUD.
BDNF polymorphisms (as measured with TaqMan genotyping assays or similar assays)
Determine if BDNF polymorphisms can serve as biomarkers to predict rTMS treatment response in Veterans with AUD.

Full Information

First Posted
June 2, 2017
Last Updated
October 11, 2023
Sponsor
VA Office of Research and Development
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1. Study Identification

Unique Protocol Identification Number
NCT03191266
Brief Title
Transcranial Magnetic Stimulation for the Treatment of Veterans With Alcohol Use Disorders
Official Title
Transcranial Magnetic Stimulation for the Treatment of Veterans With Alcohol Use Disorders
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Recruiting
Study Start Date
April 15, 2018 (Actual)
Primary Completion Date
June 3, 2024 (Anticipated)
Study Completion Date
September 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
VA Office of Research and Development

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
At least 60% of Veterans with an alcohol use disorder will relapse within 6 months of treatment, irrespective of the type of treatment they receive. This indicates that currently available interventions for treating AUD in Veterans are not effective in helping them achieve long-term sobriety. Repetitive transcranial magnetic stimulation (rTMS) is a brain stimulation method that is at the forefront of innovative, non-invasive, and safe treatments for AUD. However, there have been no studies that specifically determined the effectiveness of rTMS treatment for Veterans with AUD. This project will evaluate the effectiveness of rTMS treatment in promoting long-term abstinence in Veterans suffering from AUD. Assisting Veterans in achieving long-term and sustained sobriety is critical because it is associated with the best medical, cognitive, psychiatric, and psychosocial recovery from AUD.
Detailed Description
Due to COVID-19 restrictions, active recruiting was suspended 31MAR20. Recruitment resumed 1SEP21 The purpose of this study is to evaluate the efficacy of intermittent theta burst repetitive transcranial magnetic stimulation (rTMS) as a treatment for Veterans with an alcohol use disorder (AUD) to decrease the exceedingly high rate of relapse associated with this condition. At least 60% of those with AUD will experience a major relapse period within 6 months of treatment, irrespective of the intervention (psychosocial and/or pharmacological) employed. Consequently, the high prevalence of AUD and relapse following treatment in Veterans is associated with substantial resource allocation and costs for the DVA Health Care System. Current pharmacological and psychosocial interventions demonstrate only a moderate level of efficacy, which is reflected in the high rate of relapse in AUD. rTMS is a neurostimulation method that is at the forefront of innovative, non-invasive, and safe treatments for AUD, and the disorders that commonly co-occur with AUD. To reduce the high rate of relapse in Veterans with AUD, it is necessary for interventions to more effectively address the associated neurobiological dysfunction and salient co-occurring conditions. Accordingly, additional rigorously controlled studies are required to determine if intermittent theta burst rTMS is an effective treatment for Veterans with AUD. Participants will be recruited from VA Palo Alto Health Care System (VAPAHCS) residential substance abuse treatment clinics A double-blind randomized clinical trial with two groups: Active rTMS Treatment Group (Active rTMS) - will receive five treatments (two treatments per day) per week for 2 weeks. Sham Control Treatment group (i.e., identical rTMS experimental procedure, but no active stimulation) will receive the same frequency and duration of rTMS sessions. The proposed rTMS protocol is consistent with the FDA approved treatment regimen employed for major depressive disorders at the VAPAHCS MIRECC. Magnetic resonance imaging (MR) will be completed pre and post rTMS treatment and used to localize the left DLPFC in each participant to optimize rTMS for this region. Active and Sham rTMS groups will complete predictive measures [i.e., MR measures of anterior frontal glutamate level, blood flow, and tissue volume, diffusion tensor imaging, functional connectivity, task-based fMRI] and other outcome measures (i.e., measures of craving, mood, anxiety, neurocognition) immediately pre- and post-completion of the 2 weeks of rTMS sessions. Genetic markers (i.e., brain derived neurotrophic factor plasma levels and polymorphisms) will also be collected. Neuroimaging and genetic measures are necessary to establish potential biomarkers for prediction of rTMS treatment response, which is requisite for therapeutic optimization. For the 6 months following completion of active or sham rTMS treatment, participants will be contacted monthly, via telephone or in person, to complete a brief standardized measure of alcohol and substance use, craving, and psychiatric symptomatology to assess for changes in these variables over the previous 30 days. This project will deliver completely novel data on the efficacy of intermittent theta burst rTMS for Veterans with AUD during the first 6 months following treatment. Monitoring over the entire first 6 months following treatment is crucial, given relapse within the first 6 months of treatment is robustly related to poor psychosocial functioning over the ensuing 1-3 years. The ultimate goal of this proposal is provide treatment that more effectively promotes sustained abstinence in the Veteran with AUD, as extended abstinence is robustly associated with optimum biomedical, neuropsychological, psychiatric, and psychosocial recovery and functioning.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alcohol Use Disorder
Keywords
repetitive transcranial magnetic stimulation, alcohol use disorder, neuroimaging, relapse, Veterans

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
A double-blind randomized clinical trial with two groups: Active rTMS Treatment Group (Active rTMS) - will receive four to five treatments (two treatments per day) each week for 2 weeks. Sham Control Treatment group (i.e., identical rTMS experimental procedure, but no active stimulation) will receive the same frequency and duration of rTMS sessions. The proposed rTMS protocol is consistent with the FDA approved treatment regimen employed for major depressive disorders.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
A double-blind randomized clinical trial with two groups: Active rTMS Treatment Group (Active rTMS) - will receive four to five treatments (two treatments per day) each week for 2 weeks. Sham Control Treatment group (i.e., identical rTMS experimental procedure, but no active stimulation) will receive the same frequency and duration of rTMS sessions.
Allocation
Randomized
Enrollment
100 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
active rTMS
Arm Type
Active Comparator
Arm Description
Active rTMS will receive an intermittent rTMS stimulation protocol.
Arm Title
sham rTMS
Arm Type
Sham Comparator
Arm Description
Sham rTMS will receive all conditions except the actual intermittent theta burst rTMS stimulation.
Intervention Type
Device
Intervention Name(s)
Active rTMS
Intervention Description
Active rTMS will receive an intermittent rTMS stimulation protocol.
Intervention Type
Device
Intervention Name(s)
Sham rTMS
Intervention Description
Sham rTMS will receive all conditions except the actual intermittent theta burst rTMS stimulation.
Primary Outcome Measure Information:
Title
Frequency of abstinence from alcohol and other substances
Description
For the 6 months following completion of active or sham rTMS treatment, participants will be contacted monthly, via telephone or in person, to complete a brief standardized measure of alcohol and substance use, as well as craving, and psychiatric symptoms to assess for changes in these variables over the previous 30 days.
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Glutamate concentration in the left dorsolateral prefrontal cortex (as measured with single voxel spectroscopy)
Description
Determine if glutamate level can serve as a biomarker to predict rTMS treatment response in Veterans with AUD.
Time Frame
Baseline
Title
Volume in anterior frontal cortical regions (as measured with FreeSurfer)
Description
Determine if volume in anterior frontal cortical regions can serve as biomarkers to predict rTMS treatment response in Veterans with AUD.
Time Frame
Baseline
Title
Functional connectivity (as measured with resting state fMRI)
Description
Determine if functional connectivity can serve as a biomarker to predict rTMS treatment response in Veterans with AUD.
Time Frame
Baseline
Title
BDNF polymorphisms (as measured with TaqMan genotyping assays or similar assays)
Description
Determine if BDNF polymorphisms can serve as biomarkers to predict rTMS treatment response in Veterans with AUD.
Time Frame
Baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: The study will be open to male and females, regardless of race and ethnic origin, who are in active treatment for an alcohol use disorder (AUD). Meet Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria for AUD, and alcohol is self-identified as primary substance of misuse. Actively in treatment at VA Palo Alto HCS Addiction Treatment Service, and able to read, verbalize understanding, and voluntarily sign the Informed Consent Form prior to participation in study procedures. Participants will be accepted if taking medications specifically for the treatment of MDD, cigarette smoking, or for other psychiatric conditions. as long as the medications are not documented to lower seizure threshold must be stable on any psychotropic medication for at least 1 month prior to enrollment it would be clinically contraindicated to require participants to discontinue such medications for research. Participants will be abstinent from alcohol and non-prescribed substances for at least 7 consecutive days prior to active or sham rTMS and no participant demonstrates active acute withdrawal symptoms. Exclusion Criteria: Psychiatric: History of Schizophrenia Spectrum Disorders Bipolar Disorders A current substance use disorder that exceeds the severity of the AUD based on DSM-5 diagnostic criteria Current use of an FDA approved medication for treatment of AUD, i.e.: disulfiram acamprosate naltrexone Active current suicidal intent or plan patients with a previous clinical flag for risk for suicide will be required to have an established safety plan involving their primary psychiatrist and the treatment team before entering the clinical trial Any form of previous rTMS or electroconvulsive treatment Biomedical: Including but not limited to uncontrolled thyroid disease Unstable congestive heart failure Angina Other severe cardiac illness as defined by treatment regimen changes in the prior 3 months Cerebrovascular accident Cancer if < 1 year since end of treatment Unstable diabetes COPD requiring oxygen supplementation Alzheimer's disease Parkinson's disease Any biomedical implants with ferromagnetic content Neurostimulation devices Cardiac pacemakers or any magnetic resonance contraindications Traumatic brain injury with self-reported or observed loss of consciousness > 30 minutes Any primary or traumatically induced seizure disorder General: Lack of fluency in English Wechsler Adult Reading Test below the 7th percentile, i.e.: moderate or greater impairment in estimated general intelligence Females who are pregnant or actively attempting pregnancy conservative exclusion for magnetic resonance research Current use of any medication or substance that is documented to lower seizure threshold or has been identified as a contraindication for rTMS treatment
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Timothy C Durazzo, PhD
Phone
(650) 493-5000
Email
timothy.durazzo@va.gov
First Name & Middle Initial & Last Name or Official Title & Degree
Keith N Humphreys, PhD MA
Phone
(650) 493-5000
Ext
22814
Email
Keith.Humphreys@va.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Timothy C. Durazzo, PhD
Organizational Affiliation
VA Palo Alto Health Care System, Palo Alto, CA
Official's Role
Principal Investigator
Facility Information:
Facility Name
VA Palo Alto Health Care System, Palo Alto, CA
City
Palo Alto
State/Province
California
ZIP/Postal Code
94304-1207
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Timothy C Durazzo, PhD
Phone
650-493-5000
Email
timothy.durazzo@va.gov
First Name & Middle Initial & Last Name & Degree
Jerome A Yesavage, MD
Phone
(650) 493-5000
Ext
65147
Email
Jerome.Yesavage@va.gov
First Name & Middle Initial & Last Name & Degree
Timothy C. Durazzo, PhD

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Final datasets in machine-readable format will be submitted to PubMed Central, which will permit the easiest access All participants will be assigned a subject code, which will have no relationship to any aspect of identifiable private information. Therefore, the data associated with each participant will be completely de-identified. There will be no mechanism by which public users will be able to re-identify participant data (e.g., name, address) with the subject code.

Learn more about this trial

Transcranial Magnetic Stimulation for the Treatment of Veterans With Alcohol Use Disorders

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